Aortic valve replacement is becoming more common with almost 5,000 aortic valve replacements being carried
out on the NHS in England between April 2011 and April 2012. Transcatheter aortic valve implantation (TAVI) is an established alternative to surgical valve replacement in the management of calcified severe aortic stenosis in those with co-morbidities or adverse features (advanced age, impaired left ventricular function), or in those where open surgery may be associated with unfavourable technical features, such as previous sternotomy with a patent internal mammary graft, porcelain aorta or previous thoracic radiation, rendering the operative field hostile. A large body of experience and evidence exists predominantly for two commonly used TAVI devices; namely the balloon-expandable Edwards Sapien Valve (ESV) (Edwards Lifesciences Ltd, Irvine, California, US) and the self-expanding Medtronic
CoreValve (MCV) (Medtronic Inc, Minneapolis, Minnesota, US). Although the fundamental principle behind the two valves is similar, both involving a stent with three bioprosthetic cusps (leaflets) deployed within a calcified native aortic valve, the specific design features and potential indications are different. That said, studies have not shown a difference in mortality between the two valve types.
Patients may undergo cardiac catheterizationn to confirm a diagnosis of heart disease as well as treating and replacing a faulty valve.Whilst it can seem a daunting procedure for patients, it’s reassuring for them to know that cardiac catheterization has been around since the early 1940s with the advent of catheter-based interventions, pioneered by Andreas Gruentzig in the late 1970s. Since then, there has been considerable progress in the refinement and expansion of these techniques.
Continuing Education is important to keep physicians up to speed in the ever-changing world of invasive and non-invasive cardiac techniques. With this in mind Radcliffe Cardiology’s website is a good source of information for continuing education and includes many articles as well as round table discussions on TAVI and other procedures.
